Biochemical and pharmacological characterization of propofol infusion syndrome risk markers following high-dose propofol

Propofol infusion syndrome (PRIS) is a rare, severe complication from prolonged high-dose propofol use. Predictive biomarkers, especially in spinal surgery, remain unclear. This study aimed to biochemically and pharmacologically characterize risk markers of PRIS following high-dose propofol infusion in patients undergoing elective spinal surgery. A quasi-experimental interventional study was conducted in 2024 at Allameh Bohlool Gonabadi Hospital. Fifty-four patients aged 20-70 years scheduled for elective spinal surgery and classified as ASA physical status I or II were enrolled via convenience sampling. Baseline blood samples were collected one day prior to surgery. Propofol maintenance anesthesia were performed using standardized dosages, including continuous intravenous infusion at 10 mg/kg/h. A second blood sample was taken four hours after propofol infusion initiation. Biochemical parameters assessed included triglycerides, HDL, LDL, total cholesterol, arterial blood pH, bicarbonate ion (HCO3-), and base excess (BE). Data analysis employed paired t-tests and Pearson correlation coefficients with significance set at p < 0.05. Serum triglyceride levels increased significantly postoperatively from a mean of 153.07 mg/dL to 214.30 mg/dL (p < 0.001, CI = (- 1.19,- 0.57)). Other biochemical markers showed no statistically significant changes. Additionally, surgical duration correlated with changes in bicarbonate levels and lipid profiles. High-dose propofol infusion during elective spinal surgery was associated with a significant increase in serum triglycerides, emphasizing the potential risk of PRIS. These results underscore the importance of perioperative monitoring of lipid profiles in patients receiving high doses of propofol to enable early detection and timely intervention. A notable limitation of our study was the lack of a control group.